Guiding Cancer Control A Path to Transformation (2019) / Chapter Skim
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3 Guiding the System of Cancer Control
3 Guiding the System of Cancer Control
Pages 101-126
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From page 101... ...
In particular, the systems engineering approach requires and relies on the development of effective models of the system and its states. These models are then modified and improved under study to predict and respond to a system's likely behavior under various "futures." With that in mind, the chapter ultimately explores some essential 101
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From page 102... ...
A Case Scenario: The National Airspace System As one example of systems engineering in action, consider the U.S. National Airspace System, a complex adaptive system that is part of the larger global transportation system.
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FIGURE 3-1 The National Airspace System, with and without NextGen technologies.
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104 FIGURE 3-1 Continued
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From page 105... ...
SYSTEMS APPROACHES IN CANCER CONTROL The question that has prevailed in cancer control is how to achieve effectiveness and distributive equity while progressively diminishing the overall burden and costs. Thus, a promising path forward could be the adoption of a systems engineering approach -- like that used with the National Airspace System -- in which any sort of planning or development of strategies takes into account the entire system and its actions and interactions as a whole, instead of focusing on individual components.
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From page 106... ...
Ultimately, any overarching approach to improving cancer control will have to act in a manner that is inclusive of all these different levels. Clinical Care Even relatively simple cancer cases can involve multiple components in the cancer care system: the patient, medical, surgical and radiation oncologists, pathologists, radiologists, hospitals, insurers, and so on.
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From page 107... ...
Cancer Survivorship Presently, there is substantial variation in the provision of cancer survivorship care services, and there is no standard way of evaluating that care. Because such an effort innately involves numerous participants, starting from the individual patient to insurance companies, coordinating resources and the necessary information most relevant to the patient is a perpetual challenge.
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From page 108... ...
. While survivorship care plans have primarily focused on informing patients of the effects of their treatments and improving communication between patients and clinicians, recent reports have also begun to consider their shortcomings, which include mixed effectiveness in improving health outcomes of survivors, and ways to improve survivorship care delivery (Jacobsen et al., 2018)
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From page 109... ...
Data collected at the end of the program in 2009 indicated a reduction in colorectal cancer mortality and incidence rates among all residents of Delaware. Specifically, among African Americans, the incidence rate of colorectal cancer decreased from 66.9 per 100,000 to 44.3 per 100,000, and the mortality rate decreased from 31.2 per 100,000 to 18.0 per 100,000.
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From page 110... ...
What payers value and prioritize may not be the same as the priorities for health care providers, commercial entities, or nonprofit organizations. This section provides a case scenario of how a systems engineering approach can help inform policy analysis and decision making in a multilevel complex system.
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From page 111... ...
The traditional approach to valuing cancer control expenditures has been to use cost–benefit or cost-effectiveness analysis, but this leaves out many factors that are not easily quantified, such as the psychological stresses experienced by cancer survivors and their families or the societal costs of inequities in cancer incidence and treatment. Furthermore, different stakeholders will inevitably place different values on the various factors.
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From page 112... ...
The following case scenario was constructed, with the SMART Vaccines tool being used to consider three different kinds of hypothetical HPV vaccines for development or use in South Africa. More than 100 types of HPV exist, and at least 14 are known to cause cancer, particularly 1 Detailed information concerning the technical details and use of the software and data sets can be found in (IOM, 2012, 2013; IOM and NAE, 2015)
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From page 113... ...
; demonstration of new production platforms (this includes scientific spillovers or use of existing manufacturing approaches to produce new vaccines) ; potential litigation barriers beyond usual (an issue that comes to fore with HPV vaccines)
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From page 114... ...
Next, the other attributes in SMART Vaccines are brought into the analysis; these include domains across health, programmatic, public concerns, and scientific and business considerations as well as intangible values. According to this hypothetical scenario, the single-dose HPV-X readily fits into the immunization schedule, does not contain potential litigation barriers beyond usual, and raises public health awareness but does not beneficially demonstrate new production platforms.
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Five attributes of relevance are shown here for a demonstration using three hypothetical HPV vaccines for use in South Africa.
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Color coding denotes the contribution of individual attribute segment (health, programmatic, scientific and business, public concerns, and intangible values) to the final SMART Scores.
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It is possible to envision and apply multi-criteria decision support to many aspects of population health and medicine, especially cancer control. The next section explores that prospect.
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From page 118... ...
The Levels of Cancer Control As discussed earlier, the cancer control system spans a number of levels, and thus any model of the cancer control system will inevitably be a multi-level model with a combination of individual models that capture various aspects of the overall system. In recent years, a number of frameworks for modeling complex social systems, such as higher education, medical services, and population health, have been proposed (Rouse et al., 2019)
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From page 119... ...
In building such a model, it will be possible -- and desirable -- to draw on the large number of existing models of various aspects of the cancer control system. For example, the researchers who are part of the Cancer Intervention and Surveillance Modeling Network (CISNET)
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From page 120... ...
As the models are combined, new capabilities will appear. For example, a behavioral model that predicts the effectiveness of antismoking campaigns in getting people to stop smoking could be combined with an epidemiological model of lung cancer as a function of smoking rates to make it possible to see what effects an increase in funding for antismoking campaigns would have on lung cancer rates over the next several decades.
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From page 121... ...
In short, while the interactions between components will certainly need to be captured in the overall model, a family of models that capture individual elements of the cancer control system will form the foundation of the overall model. GUIDANCE SYSTEMS FOR CANCER CONTROL The ultimate goal of assembling such a family of models will be to create a system that can be used not just to make predictions about the performance of the cancer control system under various scenarios but ultimately to guide the cancer control system.
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From page 122... ...
Some of the concepts for such a multi-level modeling effort already exist. A 2012 article, for example, identified seven levels at which cancer care could be influenced: the individual patients, family and social supports, the clinical team, the clinical practice setting, the local community, the state health policy environment, and the national health policy environment (Taplin et al., 2012)
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From page 123... ...
shows a generic population health systems architecture, customizable for cancer control efforts, that blends contextual attributes and priorities with necessary data feeds from different channels operated on by different computational models that ultimately produce a dynamic visual dashboard to track, plan for, and initiate joint action among multiple constituents. Construction of such a population health systems architecture will make it possible to run, evaluate, and compare different scenarios and outcomes to aid in policy making.
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From page 124... ...
Finding 3-2: Systems engineering tools have been effectively applied to design, guide, influence, and improve complex adaptive systems in multiple industrial and other settings across society. Some previous analyses involving clinical care and survivorship services have recognized the role of systems engineering approaches to offer both operational insights and prospects for effective cancer control.
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From page 125... ...
2018. Systematic review of the impact of cancer survivorship care plans on health outcomes and health care delivery.
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From page 126... ...
2018. Moving beyond static survivorship care plans: A systems engineering approach to population health management for cancer survivors.
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